MEDICARE: MOUNTAINLIFE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency
2	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1871916270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAINLIFE LLC

Provider Business Mailing Address
First Line	:	4445 NORTHPARK DR.
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-0000
Country	:	US
Telephone Number	:	719-424-5345
Fax Number	:

Provider Business Practice Location Address
First Line	:	4445 NORTHPARK DR.
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-0000
Country	:	US
Telephone Number	:	719-424-5345
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. DAVID M. GARRETT
Credential	:
Telephone Number	:	719-424-5345

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	05/28/2024

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